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General NPI Number Information
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NPI Number | 1295169662
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Entity Type | Organization
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Legal Business Name | LET'S SMILE, INC.
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 1280 COTTAGE LN SE
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City | OWATONNA
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State | MN
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Zip | 55060-3677
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Country | US
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Telephone | 507-363-3023
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Fax |
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Provider Business Mailing Address
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Address Line | 1280 COTTAGE LN SE
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City | OWATONNA
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State | MN
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Zip | 55060-3677
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Country | US
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Telephone | 507-363-3023
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. HOLLY RAE JORGENSEN
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Credential | RDH
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Telephone | 507-363-3023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H8035
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License Number State | MN
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